Continuity of care and enhanced support for women experiencing antenatal distress: A pilot randomised controlled trial

Abstract

Abstract Background Evidence suggests that enhanced midwifery care may lead to reduction of antenatal distress among pregnant women. Nevertheless, the access/uptake and outcomes for expectant mothers from culturally and linguistically diverse (CALD) backgrounds may be limited. Therefore, this study investigated the effects of enhanced midwifery care in reducing antenatal distress among pregnant women presenting with elevated but sub-clinical symptoms of depression in an ethnically diverse, socio-economically, and geographically disadvantaged area in the South Western Sydney Local Health District (SWSLHD). Methods A multisite, single-blinded, randomised controlled trial was conducted with a follow-up period of 6 months. Participants included pregnant women attending the Fairfield and/or Liverpool Antenatal clinic with an Edinburgh Depression Scale (EPDS) score of 10–12 and a psychosocial assessment during the first antenatal visit. Participants were randomly allocated to either the intervention group or usual care group. The enhanced midwifery care was led by a dedicated Research Midwife (RM) that provided care coordination/navigation and social care support from pregnancy to the early postnatal period whereas the usual care group received routine antenatal care. Primary outcomes included reduction in mental ill-health symptoms assessed via EPDS and Kessler’s Psychological distress (K10) assessments whereas secondary outcomes included improvement in parenting confidence (Karitane Parenting Confidence Scale (KPCS)). Linear mixed-effects model was used to examine the effects of treatment on outcomes. Fixed-effects such as time, treatment, and time-by-group interactions were also assessed separately for each outcome variable whilst adjusting for confounders. Results 37 mothers were recruited into the study, 18 were randomised to the intervention group and 19 to the usual care group. Findings of the mixed-effects model showed significant within group differences in EPDS scores as indicated by the significant effect of time but no significant effect of treatment. Further, there were no significant effects of time, treatment, or significant interactions between time and treatment group for K10 and KPCS. Conclusion Findings showed non-significant improvements in antenatal distress and parenting confidence among expectant mothers in the enhanced midwifery care model group compared to usual care. Larger and appropriately powered trials are needed to determine whether small differences in care can reach statistical and clinical significance. Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12623000698673).